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INTRODUCTION: Electronic cigarette (e-cigarette) use among youth is common, and so efforts to regulate its use and availability are continually being made. The school environment represents an important domain for advancing health policy among youth populations. This study examines the impact of school-based e-cigarette control policies on student e-cigarette use in the context of a natural experiment. METHODS: Using three years of longitudinal student and school level data (2013/2014 to 2015/2016), from a sample of 69 secondary schools in Ontario, Canada, a generalized estimating equation approach examined the impact of school-based e-cigarette control policy changes on the prevalence of youth e-cigarette use. The main outcome of interest was current e-cigarette use, while covariates included age, gender, ethnicity, and amount of spending money in dollars per week the student has. Tests of proportion (t-tests) were used to examine whether there were any significant differences in the changes for each intervention school relative to the sample of schools that report no changes in school-level e-cigarette control policies. RESULTS: Estimates from the generalized estimating equation approach suggest that students had lower odds of using e-cigarettes in schools where an e-cigarette control policy was implemented. That is, the e-cigarette control policy decreased the adjusted odds of being an e-cigarette user (OR=0.68; 95% CI: 0.48-0.97). Examining school-specific impact, at four of six schools that had an e-cigarette control policy, the ban on the use of e-cigarettes may have lowered the prevalence of e-cigarette use. CONCLUSIONS: This is the first study to use longitudinal data to study school-level e-cigarette use and the impact of e-cigarette control policy. These results provide new evidence that school-level policies banning the use of e-cigarettes on school property may be effective in reducing e-cigarette use (or preventing it) in their current form, as seen in this natural experiment.
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We examine the relationship between total mortality, deaths due to motor vehicle accidents, cardiovascular disease and measures of business cycles for the USA, using a time-varying parameter model for the periods 1961-2010. We first present a theoretical model to outline the transmission mechanism from business cycles to health status, to motivate our empirical framework and to explain why the relationship between mortality and the economy may have changed over time. We find overwhelming evidence of structural breaks in the relationship between mortality and business cycles over the sample period. Overall, the relationship between total mortality, cardiovascular mortality and the economy has become less procyclical over time and even countercyclical in recent times for certain age groups. Deaths due to motor vehicle accidents have remained strongly procyclical. Using drugs and medical patent data and data on hours worked, we argue that important advances in medical technology and changes in the effects that working hours have on health are important reasons for this time-varying relationship. Copyright © 2015 John Wiley & Sons, Ltd.
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Accidentes de Tránsito/mortalidad , Enfermedades Cardiovasculares/mortalidad , Comercio/tendencias , Mortalidad/tendencias , Estado de Salud , HumanosRESUMEN
Studies of the effect of health care expenditures on health status suggest conflicting evidence of a relationship using data from numerous countries. We use data from the Canadian National Population Health Survey and the Canadian Institute for Health Information to estimate the relationship between per capita provincial health care expenditures and both self-assessed health status and the Health Utility Index. Our sample includes all individuals who were 18 years old or over at the beginning of the survey in 1994. We use random effects ordered probits for self-assessed health status and quantile regressions for the Health Utility Index (HUI). Our results show that provincial health care expenditures have a limited effect on self-rated health status and the HUI. It may be that self-rated health status and the HUI are noisy measures of heath status and as such, combined with the small variation observed in health care expenditure trends over the period, make the magnitude of the relationship between health care expenditures and health difficult to estimate.
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Gastos en Salud , Estado de Salud , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Canadá , Femenino , Humanos , Masculino , Persona de Mediana Edad , Autoinforme , Encuestas y Cuestionarios , Adulto JovenRESUMEN
We estimate the relationship between per capita supply of physicians, both general practitioners and specialists, and health status of Canadians. We use data from the Canadian National Population Health Survey and the Canadian Institute for Health Information. Two measures of quality of life, self-assessed health status and the Health Utility Index, are explored. Random effects ordered probits are used to model self-assessed health status, and quantile regressions are used for the Health Utility Index. A higher supply of general practitioners is correlated with better health outcomes as measured by both measures of health status, albeit for different age groups, and it is correlated with a higher HUI for some individuals who report having a chronic condition. A higher supply of specialists is correlated with worse health outcomes for the HUI for some individuals. It is possible that a higher supply of general practitioners increases the likelihood of diagnosing and treating health conditions in a timely manner and that this in turn affects health status. Specialists, due to the nature of their expertise could affect negatively health, both through the use of riskier procedures and due to their clientele being in relatively worse health. Based on our findings, we therefore would recommend maintaining a robust supply and distribution of GPs across Canada.
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Médicos Generales/provisión & distribución , Estado de Salud , Médicos/provisión & distribución , Especialización/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Canadá , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVES: We explore how alternative and complementary care use is affected by wait list length and availability of conventional care in Canada. DESIGN: We use data from the 2003 Canadian Community Health Survey, Statistics Canada and the Fraser Institute to explore the effect of longer wait times on the use of alternative therapies in general and for specific therapies: Registered Massage Therapy, Chiropractics, Physiotherapy, Homeopathy and Acupuncture. OUTCOME MEASURES: We use binary variables indicating whether the individual used various types of alternative care in the year preceding the survey. RESULTS: Wait times for specialists are associated with lower probabilities of using alternative care, but the effect are usually not statistically significant. Longer wait times for non-emergency surgery are associated with lower probabilities of using alternative care when using data from CANSIM, but very small higher probabilities of using alternative care when using data from the Fraser Institute which includes wait times for treatments for other procedures than non-emergency surgery. We find positive but extremely small effects for total wait times from the Fraser Institute. Individuals reporting unmet health care needs are more likely to use alternative care while individuals who do not have a regular physician are less likely to use it. CONCLUSIONS: Reporting unmet health care needs or no family physician have more of an impact on the use of alternative therapies than wait lists do. The evidence is not clear as to whether alternative care is sometimes used as a substitute to conventional care rather than a complement.
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Terapias Complementarias/estadística & datos numéricos , Accesibilidad a los Servicios de Salud , Servicios de Salud/provisión & distribución , Aceptación de la Atención de Salud , Listas de Espera , Academias e Institutos , Adulto , Anciano , Anciano de 80 o más Años , Canadá , Femenino , Encuestas de Atención de la Salud , Necesidades y Demandas de Servicios de Salud , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
Employing provincial data from 1979 to 2004 allows us to exploit the significant (45 percent to 60 percent) reduction in excise taxes in Eastern Canada enacted in February 1994 to estimate the impacts of cigarette taxes on birth outcomes. Empirical estimates suggest that an increase in cigarette taxes is significantly associated with lower infant mortalities. However, we also find some evidence of a counter-intuitive positive correlation between taxes and fetal deaths. Overall, conditional on methodology, we find increased lagged per capita health expenditures and the number of physicians to be significantly associated with improvements in birth outcomes.
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Muerte Fetal , Gastos en Salud , Mortalidad Infantil , Fumar , Impuestos , Canadá/etnología , Femenino , Muerte Fetal/economía , Muerte Fetal/etnología , Muerte Fetal/historia , Gastos en Salud/historia , Gastos en Salud/legislación & jurisprudencia , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Lactante , Mortalidad Infantil/etnología , Mortalidad Infantil/historia , Bienestar del Lactante/economía , Bienestar del Lactante/etnología , Bienestar del Lactante/historia , Bienestar del Lactante/legislación & jurisprudencia , Bienestar del Lactante/psicología , Recién Nacido , Embarazo , Fumar/economía , Fumar/etnología , Fumar/historia , Impuestos/economía , Impuestos/historia , Impuestos/legislación & jurisprudencia , NicotianaRESUMEN
OBJECTIVES: Several studies suggest that, on the basis of life-expectancy regressions, pharmaceutical drugs are responsible for much of the marked gains in life expectancy observed over the last 50 years. In this article, we critically appraise these studies. METHODS: We point out several modeling issues: identification of the contribution of new drugs from advances in disease management, changes in the distribution of healthcare and other confounding factors. RESULTS: We suggest that some models produce estimates of pharmaceutical productivity that are implausibly high. Other models have very large forecast errors. Finally, the models that we replicated were found to be sensitive to seemingly innocuous changes in specification. CONCLUSION: It is difficult to estimate the biomedical determinants of life expectancy using aggregate data. Analyses using individual level data or perhaps disease-specific data will probably produce more compelling results.